Mortality from pulmonary embolism among patients with lung and bronchus malignancies: National trends and forecasting from CDC WONDER (1999–2030).

Abstract

e20116 Background: Pulmonary embolism (PE) represents a major cause of preventable mortality in patients with lung cancer due to hypercoagulability, treatment-related risk, and prolonged immobility. Contemporary national trends quantifying the population-level burden of PE-related mortality in this high-risk group remain limited. We evaluated long-term mortality patterns and projected future burden of PE among U.S. adults with lung and bronchus malignancies. Methods: A retrospective population-based analysis was done using the CDC WONDER Multiple Cause-of-Death database (1999–2020). Adults aged ≥55 years with PE (ICD-10 I26) listed as the underlying cause of death and malignant neoplasms of the lung and bronchus (ICD-10 C34) listed as contributing causes were included. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated and stratified by sex, race/ethnicity, geographic region, and urban–rural classification. Temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC). Time-series forecasting was performed using autoregressive integrated moving average (ARIMA) models with Box-Cox transformation and stationarity testing (ADF/KPSS), with residual diagnostics for model validation. Results: From 1999-2020, 40,198 deaths were attributed to PE among patients with lung and bronchus malignancies. Mortality was higher among males compared with females (54.6% vs 45.3%, p < 0.05) and among non-Hispanic White individuals (85.2%). National AAMRs increased significantly during 1999–2009 (APC = 3.65%; 95% CI: 2.85–4.71; p = 0.010) and again during 2015–2020 (APC = 2.18%; 95% CI: 0.65–5.59; p = 0.004). Forecast modeling projected continued escalation in PE mortality, with AAMR reaching 3.09 per 100,000 by 2030 (95% CI: 2.61–3.50), supported by favorable model performance (RMSE = 0.070; Ljung-Box p = 0.296). Regional heterogeneity was observed, with the Northeast demonstrating early acceleration (APC = 5.81%, 1999–2008; p < 0.001) and the Midwest exhibiting sustained increases (APC = 6.98%, 2008–2020; p < 0.001). Both large central metropolitan areas (APC = 4.46%, 1999–2008; p < 0.001) and rural non-core counties (APC = 2.50%, 1999–2020; p < 0.001) demonstrated persistent upward trends. Wisconsin (AAMR = 2.6) and Alaska (2.5) exceeded the national mean mortality rate (2.03 per 100,000). Conclusions: PE-related mortality among older adults with lung cancer has increased significantly over the past two decades and is projected to continue rising. Persistent demographic and geographic disparities highlight critical gaps in thromboprophylaxis utilization, early PE detection, and equitable access to cancer-associated thrombosis care. Findings underscore the urgent need for risk-stratified preventive strategies and targeted intervention frameworks in high-risk populations.